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Delivering destinations

While some governments are very active in the process of attracting medical travellers, the majority are not fulfilling their true potential.

Costa Rica

Country attitudes to medical tourism vary. For every success story, such as Singapore, Thailand, Malaysia and India, there are many more states where medical travel flourishes in spite of, rather than because of, government action (or inaction).

This article is written by Ian Youngman, a specialist researcher and publisher of detailed research reports on insurance and medical tourism.

In India, the government, state governments, tourist boards, health and other ministries, hotels, travel agencies, hospitals, trade associations and others are all working together on promoting inbound health travel.

Some countries are particularly well organised (Singapore, take a bow). Others are ad hoc with less overall control of the developments.

At the opposite end of the spectrum, there are countries where there are a handful of medical travel agencies seeking business, but neither the government nor tourist authorities are prepared to or, in some cases, even interested to help (see feature on South Africa).

In between, there are places where one part of the government is working its socks off to promote medical travel and a rival department is doing everything it can to make it as difficult as possible for people who want to go there for treatment.

There are many different approaches and attitudes to inbound medical and health travel, and an approach that works in one country may not work if transplanted to another one, for a host of social and cultural reasons. In compiling my Guide to Medical Travel, it is clear that not only are there several different ways for countries to promote this business, but also within one country differing ways may be needed. Increasingly, countries will have to differentiate between target countries and target markets within those countries.

The attitudes, plans and campaigns of active countries in this sector are well documented in IMTJ, so instead here we focus on some of the lesser known players. Some were happy to cooperate, others refused to answer any questions.


Do countries want medical travellers?

Some obviously do not. A few countries ban travellers going to or coming from certain other countries due to political differences, the classic example being the US ban on its citizens going to Cuba, but elsewhere, most want tourists, and increasingly seek those who spend more and stay longer. Those coming for health, wellness, spa or similar holidays are very welcome as they tend to spend more money than the average package-deal traveller, are well behaved and have a high probability of returning.

The arguments in favour of medical travel are familiar: in some less well-off European countries, the extra work has helped keep dentists at home rather than migrating to richer countries, though the argument against this is that foreigners take away valuable local resources with the best doctors and nurses moving into the private sector to deal with the medical travellers.

Into this mix you have to add problem areas such as illegal organ transplants, which can colour how a country wants to portray itself. In addition, a country may well worry about the long-term consequences of this short-term gain. The industry is very new, and while there are many in it who are there for the long haul, there are others who can make a cheap quick profit in the short term, with no care about any consequences. Governments and their departments are in it for the long term, and worry about the damage that may be done to a country’s profile by such a process.



Hungary has emerged as a notable success story in recent years. Over a million Europeans go to Hungary every year for dental and cosmetic treatment. Adam Ligeti of the Hungarian National Tourist Office, says: “The development of medical and dental tourism is another way to increase tourism to Hungary. We will support any tour operators or medical service bodies that wish to promote these services. Promoting spa and dental treatments is considered a high priority in terms of wellness and fitness, as well as therapeutic.

“We mention medical and dental tourism in our brochures and ask relevant suppliers that want to market themselves to participate in exhibitions with us or take out advertising in promotional material. We also do some public relations such as writing press releases and hosting media visits for publications that are interested in this subject.”

The Hungarian National Tourist Office promotes medical tourism in terms of spa, fitness and wellness treatments, dental treatments and the healing/preventative aspects of thermal spa waters. Dental tourism is relatively new and is getting more publicity.

Few countries were prepared to answer whether or not medical travel could have an adverse result for the healthcare of its own citizens. Egypt limits any promotion to wellness and spa products, particularly those facilities available in many five-star hotels, while the Puerto Rican and Costa Rican attitudes are that public and private healthcare programmes cover the local populations’ medical and clinical needs, which are not altered by medical travel.

The Puerto Rico Tourism Company, the official tourist board, has limited efforts to attracting local medical travellers from the Caribbean Basin in the past, but is now launching a comprehensive promotional and educational programme to attract US and international patients.

Costa Rica differentiates between the wellness/health tourism sector that includes people who travel for skin treatments, relaxation, and spas – 52,000 visitors registered in 2007 – and those that travel for cosmetic surgery, where many visitors keep their reasons confidential, with only 5,000 registered visits.

However, thanks to data provided by private clinics and hospitals that provide the services for tourists, the Costa Rican Tourism Institute (ICT) knows that this is a serious under-estimate.

A spokesperson comments: “Currently, the government has set the promotional base of the country through the ICT in conjunction with the Health Ministry to portray Costa Rica as the ‘International Center of Medicine’”. For this purpose, in-depth market studies have been conducted, considering what can be offered to foreign tourists of this segment. This effort considers also the competitiveness evaluation of the country in this field and the approaches of those who offer this service to define a concrete strategy in order to strengthen this activity. This is a market niche that the current Costa Rican administration is very aware of and will support even more, which is why it has developed promotional material that is exhibited in international trade shows.”

All the countries we spoke to are continuing with current promotion and extending their activities. Hungary intends to make more mention of dental tourism. Egypt has aspects of dental and cosmetic medical tourism under review for possible promotion, and the attitude of Jamaica seems to be changing. Sharon Parris-Chambers of the Resort & Day Spa Association says: “[Ambassador] Dr Richard Bernal suggested at our health tourism and spa conference last year that the Caribbean should not invest in expensive medical technology unless it could sustain its maintenance, and not take away medical staff from the local population. [Consultant] Dr Leroy Miller, in a 2006 study on health tourism development in the Caribbean, came to the same conclusion.” Nevertheless, Jamaica’s new government, the Jamaican Labour Party, is more receptive to this sector than previous administrations and plans to promote the concept.


National Organisations

A handful of established and emerging countries have national organisations, often a public/ private partnership, to promote inbound medical travel. They are the exception. There are a few countries where associations of private hospitals act nationally and internationally, without government support. Much more common are those countries where local and overseas information sites, local medical and travel agencies, overseas agencies, hospitals and clinics, all individually promote their country. At local hospital and clinic level, some argue that it is better to spend their advertising and marketing budget on promoting their own services, rather than their country.

Few countries have set up a specific or specialised medical tourism organisation. Health ministries do not see it their job to promote inbound medical travel and so most of the burden is borne by national tourist boards, their overseas offices and promotion at trade and consumer travel shows.

The Hungarian National Tourist Office has an in-house person in the head office in Budapest who looks after all medical/spa related issues, but Egypt has no national body or anyone dedicated to the sector. For medical tourism/health, Costa Rica is a relatively new market that in recent years has experienced very important growth. The ICT has identified six hotels and four tour operators that specialise in this field and plans to promote them.



While many countries want businesses in their country to invest in facilities for medical travel, few offer anything other than kind words of encouragement. Incentives for investment tend to be more on a local than national basis. Even fewer countries do anything concrete to attract overseas investors. Local pride is often at stake, with countries wanting to give the impression that existing health businesses need no outside help. A handful, including Dubai and Jamaica, accept that locally they do not have the medical or investment know-how or funds, so there is a need to attract outsiders

A Spanish company is building Jamaica’s first hospital dedicated to medical travellers in the Montego Bay area. Bill Poinsett, administrator of Nuttall Hospital, is campaigning to get the government to subsidise investment in medical facilities and equipment.

Robert Gregory president of Jamaica Trade and Invest has a mandate to attract overseas investors and hospitals. Jamaica seeks to promote the development of spa facilities and other health/wellness investments. It makes an interesting differentiation between health and wellness tourism. Health tourism involves those visitors with medical conditions that travel to experience healing remedies. A person who travels for wellness is generally healthy, but seeks therapies to maintain his or her well-being.

Costa Rica has a law on tourist incentives that applies to domestic or foreign corporations that decide to promote the business of tourism in Costa Rica. This regulation does not include medical services of clinics and hospitals but only those that form part of the complementary chain, meaning recreation centres, airlines, hotels and agencies/tour operators. As well as incentives for investment, the authorities will consider establishing joint strategies with companies on promotion and marketing, with programmes known as “cooperative campaigns”.

Sharon Parris-Chambers concludes: “Jamaica needs more hospital beds. If all the planned new rooms are built, we will be able to promote ourselves as a niche medical and wellness destination. But if the government fails to create and execute a policy which improves the medical infrastructure, our country will not be one favoured by medical travellers.”



Among all the noise about how important medical travel is or will be to a country, few governments are being pro-active. Many are being reluctantly dragged along in the wake of hospitals and agencies promoting their country. A few are being clever and innovative. In most countries, the medical travel business is expanding despite government inaction. Some countries that we have talked to in recent months have a tacit acceptance of its importance and will be doing something about it. This is a missed opportunity. National and international investors and medical facilities will look for locations which support their initial investment, aid them in marketing and promotion, and are sympathetic to the cause. And the more educated the public gets and the more professional medical and travel agencies become, the more they will gravitate to places which want them and remove barriers such as visas.

The next time a politician jumps up and says: “We aim to be a leading country for medical tourism within five years“, ask them awkward questions about what they are going to do, when and how, to make this dream a reality. Nobody, within or outside our industry, should demand that any country seek to be a leading medical travel destination. But if the country’s government wants to go down that road, they had better be prepared to spend time and money, or it will become just another broken political promise.


Profile of the author

Ian Youngman

Ian Youngman is a writer and researcher specialising in insurance and health. He writes regularly for a variety of magazines, newsletters, and on-line services. He also publishes a range of insurance reports and undertakes research for companies. An ACII, with an honours degree in Economics from the University of Liverpool, Ian was a co-founder of The General Insurance Market Research Association. He also has widespread experience within the insurance industry at management level, working for brokers, a bank and an insurance company.